Care of the Elderly

 Developing training materials andCapacity building of medical professionals in India

Introduction• A demographic revolution is underway throughout the world.

Today, worldwide, there are around 600 million persons aged 60 years and over; this total will double by 2025 and will reach virtually two billion by 2050.

• Population ageing is an important emerging demographic phenomenon in India, warranting a strong multi-sectoral policy and programme response to deal with many significant implications for the elderly in particular and society at large

• The Global Report on Ageing in the 21st Century (2012) reinforces the observations made in India that there is multiple discrimination experienced by older persons, particularly older women, including access to health care.

Introduction• In addition, there is also extreme heterogeneity in

the demographic transition across states, resulting in vast differences in the demographic scenario across social, economic and spatial groups. • To address the issue of failing health, it is of prime

importance that good quality health care be made available and accessible to the elderly in an age-sensitive manner. • Rehabilitation, community or home based disability

support and end-of-life care should also be provided where needed, in a holistic manner, to effectively address the issue of failing health among the elderly.

Background• General improvement in the health care facilities over the

years is one of the main reasons for continuing increase in proportion of population of senior citizens. • Ensuring that they not merely live longer, but lead a secure,

dignified and productive life is a major challenge.

• The elderly population (aged 60 years or above) in India, account for 7.4% of total population in 2001.

• About 65 per cent of the aged had to depend on others for their day-to-day maintenance. Less than 20% of elderly women but majority of elderly men were economically independent.

Background• The proportion of elderly men and women physically mobile

decline from about 94 % in the age-group 60 – 64 years to about 72% for men and 63 to 65% for women of age 80 or more.

• Prevalence of heart diseases among elderly population was much higher in urban areas than in rural parts.

• By 2020, it is projected that three-quarters of all deaths in developing countries could be ageing-related. • 16 % of the world’s elderly population will be in India.

• Visual impairment and vision loss increase dramatically with age. • Cataract is mostly related to the ageing process.

• Over 10% of India’s elderly suffers from depression and 40-50 % of elderly requires psychiatric or psychological intervention at some point in their twilight years

Government Initiatives so far• The Ministry of Social Justice & Empowerment, which is the

nodal Ministry for this purpose focuses on policies and programmes for the Senior Citizens

• Article 41 of the Constitution provides that the State shall make effective provision for public assistance in cases of, old age, sickness and disablement

• The National Policy on Older Persons (NPOP) was announced in January 1999 to reaffirm the commitment to ensure the well-being of the older persons. • A National Council for Older Persons (NCOP) was constituted in

1999 under the Chairpersonship of the Minister for Social Justice and Empowerment to oversee implementation of the Policy

Government Initiatives so far• The Maintenance and Welfare of Parents and Senior Citizens Act,

2007 was enacted in December 2007, to ensure need based maintenance for parents and senior citizens and their welfare.

• In addition, other measures exist like • higher Income tax exemption, instructions to all General Health

Insurance Companies for allowing entry into health insurance scheme till 65 years of age,

• separate Railway ticket counters for senior citizens, concession in rail and Air fare,

• Old age and financial assistance for running Day Care Centers, Old Age Homes, Mobile Medicine Units, Physiotherapy clinics for older persons, Day Care Centers for Alzheimer’s Disease/Dementia patient and Training of caregivers.

Care of Elderly- the project

• Considering the importance and magnitude of the problems of the elders, IMA has taken up ‘Care of Elderly’ as a priority area and has already implemented certain activities at the National level and states. • IMA has established a National committee for Care of

Elderly to specifically look into the activities related to ‘Care of Elderly.

Objectives of the project• Capacity building of the Doctors in the National level

State level & Branch level on issues of ageing- social and medical implications and care of elderly

• To equip doctors, hospitals and voluntary associations in starting programs for free consultation or concessional treatment by identification and adoption of Elders

• To conduct free clinic and organize Geriatric Camps at regular intervals, implement Home Care service to the bedridden people

• To promote blindness control programme by training the doctors and community organisations.

Objectives of the project ..Cont• To conduct Awareness program for health workers,

Paramedical staffs and panchayat raj members, social and community leaders

• To establish, and support to establish scientifically designed old age homes and day care centers with due consideration to needs of the elderly

• To organize special training programmes for voluntary workers and caretakers

IMA seeks Government of India’s support in implementing the core component of the project- capacity building of health professionals

Developing training materials and building the capacity of health professionals

• At present the emphasis given to Geriatric Care in the medical curriculum in the country is inadequate. • As a result, medical doctors and para-medical staffs are not

properly trained to care the elderly patients, who require special attention and care.

• Hence, IMA propose to constitute a technical expert group to work on the capacity development of medical doctors and para-medics and develop specific training modules for training medical and para-medical staffs.

• Once the training modules are developed, IMA plan to conduct trainer of trainers training (ToT training) at three levels which are described later

Activities proposed

Development of training modules

• A 2-day workshop will bring together selected international and national experts in geriatric care and training to develop the training modules. • The workshop will deliberate on the structure of the training

programs- both for medical doctors and para-medicals and contents of the training.

• The workshop will review existing training materials-nationally and internationally- and develop training materials for Indian context

The output of the workshop will be • 1. Draft training modules for Trainer of Trainers• 2. Draft training modules for doctors • 3. Draft training modules for para-medics and community

volunteers

Expert committee meeting• Once the draft training modules are developed, they will be

reviewed and finalised by the technical expert group members.

• After individual members do the review, a one-day meeting will finalise the modules.

• The committee will also develop appropriate training materials like power-point slides and handbooks in addition to the modules

Trainer of trainers’ training

• The trainer of trainers training (ToT Training) is proposed at three levels, viz. National Level, State Level and District / Zonal Level

• The 3 level ToT training will be completed in 6 months.

• The district level trainers will continue to train doctors, nurses and institution-based volunteers on a regular basis.

Activities…National level Training• This is proposed to be conducted either in Delhi / Bombay. • The training session will be for 2days, which will create a pool

of around 25 national trainers across countryRegional level training• Those who have completed training at the national level

programme will conduct regional level programmes in 4 regions of the country.

• 3-5 persons from each state will participate in the regional level training programme, which will be held over 2 days.

• By this training, around 100 persons will be trained all over the country.

State level training• Those who have completed training at the regional level

programme will conduct state level programmes in the respective states/territories (N=35).

• 3-5 persons from each district / zone will participate in the state level training programme in this 2 day training.

• By this training, around 1500 persons will be trained all over the country.

Field Training• The primary training of doctors and para-medics in the field will

be at district / zonal level in selected 100 locations (at-least one per state) at the first phase.

• The trainings will be conducted over 2-days, by those who are trained in the state level programme.

• By this training, a total of 5,000 doctors/para-medics will be trained in the country within first 12 months.

Methodology of training

• The national level, regional, statelevel trainings will be conducted as modular training using trainer of trainers’ modules.

• At the district/zonal level trainings, the training will be conducted using training modules for doctors and para-medics (as the case may be) and power-point presentations

Materials

The materials used in the project will be1. Training modules for Trainer of Trainers2. Training modules for Doctors3. Training modules for para-medics and community volunteers4. Hand-books5. IEC materials

Budget

Detailed budget is given, activity-wise

National workshop

Expert committee meeting

National ToT

Regional ToT

State ToT

First phase field training

References

1. Planning commission of India. Important Issues on Ageing in India. Will social improvements for elderly grow by 8 %?.http://planningcommission.nic.in/data/ngo/csw/csw_15.pdf

2.  Central Statistics Office. Ministry of Statistics & Programme Implementation. Situation Analysis Of The Elderly in India

3. World Health Organization. Elder abuse in India. Country Report for India. Available at http://www.who.int/ageing/projects/elder_abuse/alc_ea_ind.pdf

4.  Helpage India. Problems of the Elderly. Available at http://helpageindiaprogramme.org/Elderly%20Issues/problems_of_the_elderly/index.html

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